RASMUSSEN UNIVERSITY – NUR 2759
MULTIDIMENSIONAL CARE III (MDC 3) EXAM 1
– QUESTIONS AND ANSWERS | 2026/2027 LATEST
UPDATE
SECTION 1: BREAST DISORDERS AND BREAST CANCER
Questions 1–15
1. Which characteristic most strongly distinguishes ductal carcinoma in situ (DCIS) from
invasive breast cancer?
A) The malignant cells remain confined within the mammary duct.
B) The tumor has already metastasized to distant organs.
C) The lesion originates exclusively within the nipple.
D) The condition is always associated with a palpable breast mass.
Correct Answer: The malignant cells remain confined within the mammary duct.
Rationale: DCIS consists of malignant cells located within a mammary duct without invasion
into surrounding breast tissue. It is considered a noninvasive breast cancer and may be detected
through screening mammography before a palpable mass develops. Invasive breast cancer
differs because malignant cells penetrate surrounding tissue and may eventually spread through
lymphatic or vascular pathways.
2. A woman with fibrocystic breast changes reports breast tenderness that becomes worse
immediately before menstruation. Which explanation is most appropriate?
A) The symptoms indicate metastatic breast cancer.
B) Hormonal fluctuations can cause cyclic breast swelling and tenderness.
C) Fibrocystic changes usually result from bacterial infection.
D) The symptoms indicate that a biopsy is immediately required.
Correct Answer: Hormonal fluctuations can cause cyclic breast swelling and tenderness.
Rationale: Fibrocystic breast changes commonly produce tenderness, swelling, and nodularity
that fluctuate with the menstrual cycle. Hormonal changes involving estrogen and progesterone
contribute to these symptoms. Cyclic symptoms alone do not establish malignancy, although any
persistent, suspicious, or changing breast finding still requires appropriate clinical evaluation.
,3. Which finding is most concerning for invasive breast cancer rather than uncomplicated
fibrocystic changes?
A) Bilateral tenderness before menstruation
B) Generalized breast fullness that resolves after menstruation
C) A persistent irregular, poorly defined breast mass
D) Cyclic discomfort relieved after the menstrual period
Correct Answer: A persistent irregular, poorly defined breast mass
Rationale: An invasive breast carcinoma may present as an irregular, poorly defined mass that
remains present rather than fluctuating with hormonal cycles. Fibrocystic changes commonly
produce tender, mobile, or cyclic nodularity. A persistent suspicious mass requires diagnostic
evaluation rather than assuming that it represents benign hormonal breast changes.
4. Which patient history represents a recognized nonmodifiable risk factor for breast
cancer?
A) Regular alcohol consumption
B) Physical inactivity
C) Obesity after menopause
D) A pathogenic BRCA1 mutation
Correct Answer: A pathogenic BRCA1 mutation
Rationale: BRCA1 and BRCA2 mutations are inherited genetic risk factors associated with
increased breast cancer risk. Alcohol use, physical inactivity, and obesity are potentially
modifiable factors. A strong family history can also increase risk, but the presence of a
pathogenic inherited mutation is a particularly important genetic consideration.
5. When teaching breast self-awareness, which instruction is most appropriate?
A) Report a new or persistent breast change to a healthcare provider.
B) Perform a breast examination only when experiencing pain.
C) Avoid reporting nipple changes unless they persist for several years.
D) Consider self-examination a substitute for recommended screening.
Correct Answer: Report a new or persistent breast change to a healthcare provider.
,Rationale: Breast self-awareness involves becoming familiar with the normal appearance and
feel of the breasts and reporting significant changes. It does not replace recommended screening
or diagnostic evaluation. New masses, skin changes, nipple abnormalities, or other persistent
changes should be assessed appropriately rather than dismissed as normal variation.
6. A patient asks why mammography can detect some breast cancers before a lump can be
felt. What is the best response?
A) Mammography measures circulating tumor markers.
B) Mammography can identify differences in breast tissue density.
C) Mammography directly identifies metastatic cancer cells.
D) Mammography eliminates the need for tissue diagnosis.
Correct Answer: Mammography can identify differences in breast tissue density.
Rationale: Mammography uses x-rays to visualize differences in breast tissue density and can
identify abnormalities that are not palpable. It is a screening and diagnostic imaging tool, not a
blood test or definitive tissue diagnosis. Suspicious imaging findings may require additional
diagnostic procedures such as biopsy.
7. A breast biopsy identifies malignant cells that have penetrated the duct wall into
surrounding tissue. How should the nurse interpret this finding?
A) The cancer is limited to LCIS.
B) The finding represents a benign fibroadenoma.
C) The cancer is invasive.
D) The finding represents uncomplicated fibrocystic change.
Correct Answer: The cancer is invasive.
Rationale: Invasive breast cancer occurs when malignant cells extend beyond the duct or lobule
into surrounding breast tissue. DCIS remains confined to the duct, whereas LCIS involves
lobular cells and increases future invasive cancer risk. Fibrocystic changes and fibroadenomas
are benign conditions and do not demonstrate malignant invasion.
8. Which assessment finding is characteristic of advanced invasive breast cancer?
A) Breast tenderness that occurs only before menstruation
B) A freely mobile, rubbery mass
C) Symptoms that disappear after menstruation
, D) Skin dimpling or peau d’orange
Correct Answer: Skin dimpling or peau d’orange
Rationale: Advanced invasive breast cancer can produce skin dimpling because tumor-
associated fibrosis affects Cooper ligaments. Peau d’orange describes edematous, thickened,
pitted breast skin resembling an orange peel. Cyclic tenderness and mobile rubbery masses are
more consistent with benign breast conditions, although any suspicious finding requires
evaluation.
9. Which description best characterizes a fibroadenoma?
A) A benign, well-defined, freely mobile solid breast mass
B) A malignant tumor that routinely metastasizes to bone
C) A ductal infection caused by bacterial invasion
D) A diffuse inflammatory process involving both breasts
Correct Answer: A benign, well-defined, freely mobile solid breast mass
Rationale: Fibroadenomas are benign solid tumors that commonly occur in younger women.
They are typically well defined, mobile, and rubbery on examination. Although these
characteristics favor a benign process, a new breast mass still requires appropriate assessment
because physical findings alone cannot definitively exclude malignancy.
10. Which patient has the strongest indication for enhanced breast cancer surveillance?
A) A woman with occasional premenstrual breast tenderness
B) A woman with a pathogenic BRCA mutation
C) A woman with a history of uncomplicated fibroadenoma
D) A woman whose breast tenderness resolves after menstruation
Correct Answer: A woman with a pathogenic BRCA mutation
Rationale: BRCA mutations substantially increase hereditary breast cancer risk and may
warrant intensified surveillance and consideration of risk-reducing strategies. Cyclic tenderness
and benign fibroadenoma are not equivalent hereditary risk factors. Screening recommendations
should be individualized according to genetic risk, family history, age, and clinical guidance.
11. Which statement about lobular carcinoma in situ (LCIS) is most accurate?
A) LCIS always represents an invasive malignancy.
B) LCIS is located only within the mammary ducts.
MULTIDIMENSIONAL CARE III (MDC 3) EXAM 1
– QUESTIONS AND ANSWERS | 2026/2027 LATEST
UPDATE
SECTION 1: BREAST DISORDERS AND BREAST CANCER
Questions 1–15
1. Which characteristic most strongly distinguishes ductal carcinoma in situ (DCIS) from
invasive breast cancer?
A) The malignant cells remain confined within the mammary duct.
B) The tumor has already metastasized to distant organs.
C) The lesion originates exclusively within the nipple.
D) The condition is always associated with a palpable breast mass.
Correct Answer: The malignant cells remain confined within the mammary duct.
Rationale: DCIS consists of malignant cells located within a mammary duct without invasion
into surrounding breast tissue. It is considered a noninvasive breast cancer and may be detected
through screening mammography before a palpable mass develops. Invasive breast cancer
differs because malignant cells penetrate surrounding tissue and may eventually spread through
lymphatic or vascular pathways.
2. A woman with fibrocystic breast changes reports breast tenderness that becomes worse
immediately before menstruation. Which explanation is most appropriate?
A) The symptoms indicate metastatic breast cancer.
B) Hormonal fluctuations can cause cyclic breast swelling and tenderness.
C) Fibrocystic changes usually result from bacterial infection.
D) The symptoms indicate that a biopsy is immediately required.
Correct Answer: Hormonal fluctuations can cause cyclic breast swelling and tenderness.
Rationale: Fibrocystic breast changes commonly produce tenderness, swelling, and nodularity
that fluctuate with the menstrual cycle. Hormonal changes involving estrogen and progesterone
contribute to these symptoms. Cyclic symptoms alone do not establish malignancy, although any
persistent, suspicious, or changing breast finding still requires appropriate clinical evaluation.
,3. Which finding is most concerning for invasive breast cancer rather than uncomplicated
fibrocystic changes?
A) Bilateral tenderness before menstruation
B) Generalized breast fullness that resolves after menstruation
C) A persistent irregular, poorly defined breast mass
D) Cyclic discomfort relieved after the menstrual period
Correct Answer: A persistent irregular, poorly defined breast mass
Rationale: An invasive breast carcinoma may present as an irregular, poorly defined mass that
remains present rather than fluctuating with hormonal cycles. Fibrocystic changes commonly
produce tender, mobile, or cyclic nodularity. A persistent suspicious mass requires diagnostic
evaluation rather than assuming that it represents benign hormonal breast changes.
4. Which patient history represents a recognized nonmodifiable risk factor for breast
cancer?
A) Regular alcohol consumption
B) Physical inactivity
C) Obesity after menopause
D) A pathogenic BRCA1 mutation
Correct Answer: A pathogenic BRCA1 mutation
Rationale: BRCA1 and BRCA2 mutations are inherited genetic risk factors associated with
increased breast cancer risk. Alcohol use, physical inactivity, and obesity are potentially
modifiable factors. A strong family history can also increase risk, but the presence of a
pathogenic inherited mutation is a particularly important genetic consideration.
5. When teaching breast self-awareness, which instruction is most appropriate?
A) Report a new or persistent breast change to a healthcare provider.
B) Perform a breast examination only when experiencing pain.
C) Avoid reporting nipple changes unless they persist for several years.
D) Consider self-examination a substitute for recommended screening.
Correct Answer: Report a new or persistent breast change to a healthcare provider.
,Rationale: Breast self-awareness involves becoming familiar with the normal appearance and
feel of the breasts and reporting significant changes. It does not replace recommended screening
or diagnostic evaluation. New masses, skin changes, nipple abnormalities, or other persistent
changes should be assessed appropriately rather than dismissed as normal variation.
6. A patient asks why mammography can detect some breast cancers before a lump can be
felt. What is the best response?
A) Mammography measures circulating tumor markers.
B) Mammography can identify differences in breast tissue density.
C) Mammography directly identifies metastatic cancer cells.
D) Mammography eliminates the need for tissue diagnosis.
Correct Answer: Mammography can identify differences in breast tissue density.
Rationale: Mammography uses x-rays to visualize differences in breast tissue density and can
identify abnormalities that are not palpable. It is a screening and diagnostic imaging tool, not a
blood test or definitive tissue diagnosis. Suspicious imaging findings may require additional
diagnostic procedures such as biopsy.
7. A breast biopsy identifies malignant cells that have penetrated the duct wall into
surrounding tissue. How should the nurse interpret this finding?
A) The cancer is limited to LCIS.
B) The finding represents a benign fibroadenoma.
C) The cancer is invasive.
D) The finding represents uncomplicated fibrocystic change.
Correct Answer: The cancer is invasive.
Rationale: Invasive breast cancer occurs when malignant cells extend beyond the duct or lobule
into surrounding breast tissue. DCIS remains confined to the duct, whereas LCIS involves
lobular cells and increases future invasive cancer risk. Fibrocystic changes and fibroadenomas
are benign conditions and do not demonstrate malignant invasion.
8. Which assessment finding is characteristic of advanced invasive breast cancer?
A) Breast tenderness that occurs only before menstruation
B) A freely mobile, rubbery mass
C) Symptoms that disappear after menstruation
, D) Skin dimpling or peau d’orange
Correct Answer: Skin dimpling or peau d’orange
Rationale: Advanced invasive breast cancer can produce skin dimpling because tumor-
associated fibrosis affects Cooper ligaments. Peau d’orange describes edematous, thickened,
pitted breast skin resembling an orange peel. Cyclic tenderness and mobile rubbery masses are
more consistent with benign breast conditions, although any suspicious finding requires
evaluation.
9. Which description best characterizes a fibroadenoma?
A) A benign, well-defined, freely mobile solid breast mass
B) A malignant tumor that routinely metastasizes to bone
C) A ductal infection caused by bacterial invasion
D) A diffuse inflammatory process involving both breasts
Correct Answer: A benign, well-defined, freely mobile solid breast mass
Rationale: Fibroadenomas are benign solid tumors that commonly occur in younger women.
They are typically well defined, mobile, and rubbery on examination. Although these
characteristics favor a benign process, a new breast mass still requires appropriate assessment
because physical findings alone cannot definitively exclude malignancy.
10. Which patient has the strongest indication for enhanced breast cancer surveillance?
A) A woman with occasional premenstrual breast tenderness
B) A woman with a pathogenic BRCA mutation
C) A woman with a history of uncomplicated fibroadenoma
D) A woman whose breast tenderness resolves after menstruation
Correct Answer: A woman with a pathogenic BRCA mutation
Rationale: BRCA mutations substantially increase hereditary breast cancer risk and may
warrant intensified surveillance and consideration of risk-reducing strategies. Cyclic tenderness
and benign fibroadenoma are not equivalent hereditary risk factors. Screening recommendations
should be individualized according to genetic risk, family history, age, and clinical guidance.
11. Which statement about lobular carcinoma in situ (LCIS) is most accurate?
A) LCIS always represents an invasive malignancy.
B) LCIS is located only within the mammary ducts.
